The article conclude the core of the informed consent from the development of the right , the essential of the medical privacy regulations. It analyze the conflict between the informed consent and medical privacy regulations used in the practice of clinical, point out the coherence of the two and the applicable qualifications of each.

Mannose-binding lectin(MBL) is a key component of the innate immune system that plays a pluripotent role in natural defense.MBL genetic variants are associated with increased susceptibility to and the severity and prognosis of various diseases.The association between low MBL-producing allelic variants and disease risk and/or severity is particularly strong in infectious and autoimmune diseases.Enhanced risk for disease by low MBL producers is particularly the case for children and immunocompromised patients,especially when primary and secondary immune deficiencies coexist.Therefore the use of MBL testing and replacement therapy has reached the threshold of personalized medicine.The author presents a review of the role of MBL in health and diseases,the advances in MBL testing methodology and MBL related therapies.

AIM:To investigate the influence and mechanisms of human pancreatic cancer tumor microenvironments on T-cell immunoglobulin mucin-3 (TIM-3) expression and function of dendritic cells (DCs).METHODS:Tumor-infiltrating dendritic cells (TIDC) and para-carcinoma tissue DCs were isolated by Ficoll-Hypaque density centrifugation from trypsinized pancreatic carcinoma tissues, and the peripheral blood mononuclear cells were isolated from pancre-atic cancer patients or healthy people.The expression of TIM-3 on DCs was detected by flow cytometry.DCs isolated from healthy people peripheral blood mononuclear cells were induced by rhGM-CSF and IL-4.The expression of TIM-3 in the DCs treated with the culture supernatants of Capan-2, SW1990 and Panc-1 pancreatic cancer cells or human skin fibroblast (Hs27) cells for 48 h, and in the DCs treated with supernatants of Capan-2 cells, anti-VEGF-R2, anti-IL-10 and EP2 re-ceptor blocking peptide were evaluated by flow cytometry.The releases of IFN-βand IL-12 in the culture supernatants of DCs pretreated with monoclonal antibody ( mAb) to TIM-3 or DNase+RNase, followed by stimulation with apoptotic Ca-pan-2 cells, were detected by ELISA.RESULTS:DCs in tumor microenvironments had higher expression of TIM-3 than the DCs from para-carcinoma tissues and pancreatic cancer patient or healthy people peripheral blood ( P<0.01 ) .TIM-3 expression in the DCs treated with the culture supernatants of Capan-2, SW1990 and Panc-1 pancreatic cancer cells for 48 h was much higher than that in Hs27 cells (P<0.05).Treatment with a combination of anti-VEGF-R2, anti-IL-10 and EP2 receptor blocking peptide largely diminished the upregulation of TIM-3 on the DCs mediated by Capan-2 cell superna-tants (P<0.05).The concentrations of IFN-βand IL-12 in the DCs with high expression level of TIM-3 were lower than those in the DCs with low TIM-3 expression level.Treatment with mAb to TIM-3 resulted in much more IFN-βand IL-12 releases (P<0.01), but DNase+RNase made this effect disappear.CONCLUSION:TIM-3 serves as a negative regula-tor of DCs innate immune responses in the pancreatic cancer microenvironments.The secretion of soluble factors to tumor microenvironment by pancreatic cancer cells, including IL-10, VEGF and PGE2 , may contribute to the regulation of TIM-3 expression.

Multicultural nursing starts late in our country. At present, the domestic scholars′research is focusing on the influencing factors of multi-cultural nursing ability and cultivating mode. There are few studies pay attention to the cultural competency assessment tool which is limited to nursing students in school. I believe that establishing evaluation tools that suit our national condition, efficient and comprehensive will help reflecting the multicultural nursing ability and the training effect objectively and also promoting the development of multi-cultural care in China.

Objective To study on the factors of countercurrent occured in hysterosalpingography to improve the understanding of countercurrent.Methods 180 patients who underwent hysterosalpingography due to infertility were recruited,and 63 of them who were involved in countercurrent in the process of hysterosalpingography were analyzed statistically.Results The single factor analy-sis demonstrated that such four factors of primary/secondary infertility,menstrual clean days,tubal obstruction or not,and depth of cannula were associated with countercurrent,while Logistic regression analysis indicated that the factors of menstrual clean days, tubal obstruction or not,and depth of cannula during the hysterosalpingography operation were closely related.Conclusion Counter-current are caused by the comprehensive impact of several comprehensive factors like menstrual clean day,tubal obstruction or not, and cannula operation.Therefore adequate preparation should be made before and during the operation,to reduce the occurrences of countercurrent.

To study and compare the protective effects of Cordyceps sinensis from different habitats on acute injury of hepatic tissue induced by carbon tetrachloride ( CCl4 ) . Methods:The rat model of acute injury of hepatic tissue induced by CCl4 was established. The biochemical indicators of alanine aminotranferease ( ALT) and aspartate aminotransferease ( AST) in the serum and superoxide dismutase ( SOD) and L-glutathione( GSH) in the liver tissue were detected, and the liver tissue HE staining was used for the histopathology determination. Results:Compared with those in the model group, the levels of AST and ALT in the serum were sig-nificantly reduced, the levels of SOD and GSH in the liver tissue were notably increased, and the necrosis of liver cells was improved in Cordyceps sinensis groups at low, medium and high dose from different habitats (P<0. 05), however, the differences between the two different habitats were not significant (P>0. 05). Conclusion: Cordyceps sinensis from Qinghai and Tibet shows some positive differences in the protective effect on the acute chemical liver injury induced by CCl4 in rats,however, the differences are not remarka-ble.

Objective To explore human cytomegalovirus UL97 mutations related to ganciclovir resistance in hematopoietic stem cell transplant (HSCT) recipients.Methods A total of 43 patients,including 24 males and 19 females,with an average age of 21 years old,who had HCMV DNAemia for more than two weeks after HSCT between 2008 and 2010 in Peking University People's Hospital,were included in this prospective study.UL97 GCV resistance mutations were investigated in 49 plasma specimens collected from those patients.GCV resistance mutations such as UL97 M460V/I,H520Q,A591V,A594V,L595S/F,and C603W,were analyzed by modified PCR-RFLP methods.UL97 mutations related to GCV resistance were assayed by the method of PCR-direct sequencing (PCR-DS).An amplified refractory mutation system real-time PCR (ARMS RT-PCR) was developed for the detection of UL97 A594V mutation.Results Eight known UL97 ganciclovir resistance mutations were not detected by PCR-RFLP and PCR-DS.Four new UL97 mutations like UL97 R494P,T502A,N558D,and G561S,were detected by PCR-DS.The ARMS RT-PCR for detecting of UL97 A594V was established successfully.The lower limit of detection of the method was at least 7.5 × 102 copies/ml combined with the use of nucleic acid extraction reagent.UL97 A594V resistance mutation was identified by the method of ARMS RT-PCR in two HSCT recipients.The rate of UL97 A594V mutation was 4.7％ (2/43) in HSCT recipients.Conclusion The ARMS RT-PCR assay represented a sensitive method for the identification of UL97 A594V mutation.

Sudden sensorineural hearing loss (SSHL),which is a common and frequently encountered disease,is considered to be a medical emergency in otolaryngology.The prevalence of SSHL is increasing in China.The pathogenesis of SSHL is not clear yet.Microcirculatory disorder of inner ear is considered as one of the most important causes of SSHL.In recent years,several reports have found the levels of serum lipids were changed in patients affected by SSHL.The relationship between SSHL and serum lipids was reviewed to provide new ideas for the diagnosis and treatment of SSHL.

Objective To observe the protective effect of different doses of left carnitine on cardiomyocyte function in children with viral myocarditis.Methods94 cases of children with viral myocarditis were selected and divided into observation group and control group according to the random number table, 47 cases in each group.Both groups were treated with fructose 1,6-diphosphate(100~250mg/kg, add 150mL of 10% glucose in intravenous infusion, 1times/d) combined with left carnitine.Large dose group of left carnitine 100 mg/kg, low dose group 50mg/kg, all added 150mL of 5% glucose intravenous infusion, 1 times/d.The total effective rate, creatine kinase(CK), creatine kinase isoenzyme (CK-MB),lactate dehydrogenase (LDH), cardiac ejection fraction(EF), ventricular short axis shortening (FS) And the total incidence of adverse reactions were compared between two groups.ResultsThe total effective rates of two group were 93.62% and 87.23%.The level of CK,CK-MB,LDH in two groups were significantly decreased after treatment of two weeks(P<0.05), EF, FS were increased after treatment of two weeks(P<0.05).There was no significant difference in CK, CK-MB, LDH, EF and FS between the high dose group and the low dose group after treatment of two weeks.The overall incidence of adverse reactions in the high dose group was 25.53%, which was lower than that in the low dose group (8.51%,P<0.05).ConclusionThe use of low-dose left carnitine in children with viral myocarditis can effectively remove free radicals, protect cardiomyocyte function and improve myocardial energy metabolism and cardiac function, and safer than high-dose groups.

OBJECTIVE Identify the effect of Brandt-Daroff exercises for positional vertigo with atypical positioning nystagmus.METHODS 11 cases of positional vertigo during 2006～2007 with atypical positioning nystagmus when carrying Dix-Hallpike and roll test,the nystagmus had the follwing characters:poly-positions,atypical direction,long lasting(more than 3 mins),no fatigue.After ruling out centrul neural system disorders,the patients were instructed to do Brandt-Daroff exercises 2-3 times/day,and 6-10 times every time.RESULTS After doing the exercises for 3-4 days,the vertigo of all the 11 cases were all relieved.After 1-2 weeks,10 cases were cured,syptom of the other 1 was relieved significantly,and the nystagmus was alleviated.CONCLUSION Cases with atypical positioning nystagmus may present a different kind of BPPV related with the otolith and vestibular nerve disease.Brandt-Daroff exercises was a good method for the atypical positioning nystagmus cases.